Single-center randomized controlled trial of the effect of estradiol gel for the endometrial repair of patients after the early missed abortion
Objective:To investigate the efficacy and safety of estradiol gel for the endometrial repair of patients after the early missed abortion.Methods:240 patients with early missed abortion who wanted evacuation and curettage in the hospital were selected and were divided into three groups(80 cases in each group)by random number table meth-ods from November 2021 to June 2022.The patients in group A were treated with basal therapy,the patients in group B were treated with basal therapy combined with drospirenone and ethinylestradiol tablets,and the patients in group C were treated with basal therapy combined with estradiol gel.The endometrial thickness at the postoperative different time points,the effect of the treatment of the abnormal menstruation,the duration of vaginal bleeding,the time of the first menstrual cycles restoration after abortion,the incidences of the intrauterine adhesion,the uterine cavity effusion,the pelvic inflammatory diseases,the decreased menstrual volume and the amenorrhoea,the adverse reactions rate and the pregnancy situation within 1 year of the postoperative follow-up of the patients were compared among the three groups.Results:The endometrial thickness of the patients in group C in two weeks after operation was significantly higher than that of the patients in group B and in group A.The endometrial thickness of the patients in the three groups after 1 cycle or 3 cycles of treatment had increased significantly,and which(7.86±2.27 mm or 8.05±2.62 mm)of the patients in group C was significantly higher than that(5.52±1.84 mm or 6.01±1.75 mm)of the patients in group B and that(4.92±1.53 mm or 5.07±1.62 mm)of the patients in group A.The endometrial thickness of the patients in group B after 3 cycles of treatment was significantly higher than that after 1 cycle of treatment,and which of the patients in group C after 3 cycles of treatment was significantly higher than that after 2 cycles of treatment(all P＜0.05).The effective rate of the treatment of the abnormal menstruation(93.8％)of the patients in group C was significantly higher than that(80.0％)of the patients in group B and that(66.3％)of the patients in group A.The pro-portions of the intrauterine adhesion,the decreased menstrual volume,the uterine cavity effusion and the pelvic in-flammatory disease of the patients in group C were significantly lower than those of the patients in group B and those of the patients in group A.The vaginal bleeding time and the menstrual recovery time of the patients in group B were the shortest(P＜0.05).There was no significant difference in the rates of the bleeding and the amenorrhea of the patients after treatment between group C and group B(P＞0.05).The total incidence of the drug adverse reactions(3.8％)of the patients in group C had no significantly different from that(2.5％)of the patients in group A(P＞0.05),but which of the patients in both groups was significantly lower than that(15.0％)of the patients in group B(P＜0.05).5 cases in group C,7 cases in group B and 4 cases in group A were lost to follow-up within 1 year after operation.The re-pregnancy rate and the live birth rate(68.0％and 88.2％)of the patients in group C within 1 year after operation were significantly higher than those(39.7％and 62.1％)of the patients in group B and than those(29.0％and 59.1％)of the patients in group A(all P＜0.05).Conclusion:The application of estradiol gel for the patients with early missed a-bortion can effectively promote their endometrial repair and accelerate their menstruation recovery,and the efficacy of which is better than that of the drospirenone and ethinylestradiol tablets.Furthermore,estradiol gel can reduce the oc-currences of the postoperative complications of the patients,such as uterine adhesions and vaginal bleeding,and which has low adverse reaction rate and higher safety,and it can effectively prevent the occurrence of infertility of the patients in the long term.
Operation of missed abortionEstradiol gelDrospirenone and ethinylestradiolEndometriumMenstrua-tionComplicationPregnancy after operation
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